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Le bilan de l’activite du centre de traitement Ebola (CTE) de Forecariah (Guinee maritime) du 23 avril au 5 juin 2015 est ici presente. La charge virale du virus Ebola a ete evaluee par la mesure du cycle threshold (Ct). Cent trente personnes ont fait l’objet d’un triage, 24 (18,5 %) ne repondant pas aux criteres de l’OMS d’une fievre hemorragique n’ont pas ete admises au CTE. Parmi les 106 patients admis au CTE, 72 (67,9 %) ont ete declares non-cas a l’issu de la negativite de deux PCR pratiquees a 48 heures d’intervalle. Trente-quatre patients etaient atteints de maladie a virus Ebola (MVE): 19 femmes et 15 hommes (sex-ratio: H/F = 0,78), âge moyen: 33,51 ± 20,1 ans (extremes 42 jours a 70 ans), dont six enfants de moins de huit ans. Leur Ct initial median etait de 21,6 ± 6,3 cycles. La notion de contact n’a ete retrouvee que chez 20 d’entre eux (58,8 %). Treize patients ont gueri: six hommes et sept femmes, d’âge moyen 31,8 ans (extremes: 4–52 ans), presentant a l’admission un Ct median egal a 21,88 ± 6,2 cycles (extremes: 17,6–31,7). Parmi les six enfants de moins de huit ans, un seul a survecu. Vingt et un patients avec MVE sont decedes (61,76 %): 9 hommes et 12 femmes, d’âge moyen 34 ± 24 ans (extremes: 42 jours–70 ans), presentant a l’admission un Ct median egal a 18 ± 7 cycles (extremes: 12–24). Le seul facteur associe a la mortalite etait le Ct a l’admission (p = 0,0004). Il ressort de cette analyse statistique que plus la charge virale est elevee, plus la probabilite d’avoir une forte letalite est presente. L’âge, le sexe, la notion de contact, le delai entre l’apparition des symptomes et l’admission n’etaient pas predictifs de la survenue du deces dans cette serie.

La maladie a virus Ebola (MVE) occasionne une forte letalite, meme prise en charge dans un centre de traitement Ebola (CTE). Des examens de laboratoire de base peuvent aider a mieux en comprendre la physiopathologie, a guider le traitement et a etablir des conduites a tenir simples sur la base de protocoles adaptes a l’exercice de la medecine en milieu precaire et dangereux pour les soignants. Base sur quelques cas cliniques de patients pris en charge au CTE de Forecariah en Guinee, tenu par la Croix-Rouge francaise, cet article decrit les difficiles conditions d’exercice de la medecine aupres des patients atteints de MVE. Il a pour objectif de participer a la reduction des pertes de chance de survie des patients, par l’instauration d’une confrontation clinico-biologique simple et par l’amelioration de la formation des personnels de sante.

International audience; OBJECTIVES: To assess trends and risk factors of ventilator-associated pneumonia according to age, particularly in the elderly admitted to French ICUs between 2007 and 2014. DESIGN: Multicenter, prospective French national Healthcare-Associated Infection surveillance network of ICUs ("Réseau REA-Raisin"). SETTINGS: Two-hundred fifty six ICUs in 246 settings in France. PATIENTS: Included were all adult patients hospitalized greater than or equal to 48 hours in ICUs participating in the network. INTERVENTIONS: Ventilator-associated pneumonia surveillance over time. MEASUREMENTS AND MAIN RESULTS: Overall and multidrug-resistant organism-related ventilator-associated pneumonia incidence rates were expressed per 1,000 intubation days at risk. Age was stratified into three groups: young (18-64 yr old), old (65-74 yr old), and very old (75+ yr old). Age-stratified multivariate mixed-effects Poisson regressions were undertaken to assess trends of ventilator-associated pneumonia incidence over time, with center as the random effect. Ventilator-associated pneumonia risk factors were also evaluated. Of 206,223 patients, 134,510 were intubated: 47.8% were young, 22.3% were old, and 29.9% were very old. Ventilator-associated pneumonia incidence was lower in the very old group compared with the young group (14.51; 95% CI, 16.95-17.70 vs 17.32; 95% CI, 16.95-17.70, respectively, p \textless 0.001). Methicillin-resistant Staphylococcus aureus and third-generation cephalosporin-resistant Enterobacteriaceae were identified more frequently in very old patients (p \textless 0.001 and 0.014, respectively). Age-stratified models disclosed that adjusted ventilator-associated pneumonia incidence decreased selectively in the young and old groups over time (adjusted incidence rate ratios, 0.88; 95% CI, 0.82-0.94; p \textless 0.001 and adjusted incidence rate ratios, 0.95; 95% CI, 0.86-1.04; p = 0.28, respectively). Male gender and trauma were independently associated with ventilator-associated pneumonia in the three age groups, whereas antibiotics at admission was a protective factor. Scheduled surgical ICU and immunodeficiency were risk factors of ventilator-associated pneumonia in the old group (p = 0.003). CONCLUSIONS: Ventilator-associated pneumonia incidence is lower but did not decrease over time in very old patients compared with young patients.

OBJECTIVETo assess the temporal trend of reported occupational blood and body fluid exposures (BBFE) in French healthcare facilities.METHODRetrospective follow-up of reported BBFE in French healthcare facilities on a voluntary basis from 2003 to 2012 with a focus on those enrolled every year from 2008 to 2012 (stable cohort 2008–12).FINDINGSReported BBFE incidence rate per 100 beds decreased from 7.5% in 2003 to 6.3% in 2012 (minus 16%). Percutaneous injuries were the most frequent reported BBFE (84.0% in 2003 and 79.1% in 2012). Compliance with glove use (59.1% in 2003 to 67.0% in 2012) and sharps-disposal container accessibility (68.1% in 2003 to 73.4% in 2012) have both increased. A significant drop in preventable BBFE was observed (48.3% in 2003 to 30.9% in 2012). Finally, the use of safety-engineered devices increased from 2008 to 2012.CONCLUSIONOf the 415,209 hospital beds in France, 26,158 BBFE could have occurred in France in 2012, compared with 35,364 BBFE in 2003. Healthcare personnel safety has been sharply improved during the past 10 years in France.Infect. Control Hosp. Epidemiol. 2015;36(8):963–968

Introduction Le controle de la resistance aux antibiotiques (ATB) passe par une maitrise de la consommation des ATB (CAB). La surveillance en reseau des CAB dans les etablissements de sante (ES) est un des elements permettant d’aider a la maitriser. Le but de cette etude etait d’observer l’evolution des CAB dans un reseau de surveillance, a l’echelle d’une region. Materiels et methodes Les consommations etaient exprimees en doses definies journalieres (DDJ)/1000 journees d’hospitalisation (JH). L’evolution des CAB, sur l’ensemble de l’ES, a ete mesuree sur une cohorte d’ES de la region ayant participe tous les ans, de 2013 a 2017. Une analyse a aussi ete realisee specifiquement sur les CAB en reanimation. Resultats Sur les 115 ES inclus, les CAB totales ont diminue de 418,7 a 385,5 DDJ/1000 JH (− 7,9 %) pendant cette periode. Les CAB de cephalosporines de 3e generation (C3G) ont augmente de 32,1 a 36,1 DDJ/1000 JH (+ 12 %). Avec une diminution pour la ceftriaxone (CRO, −14 %) et une augmentation pour le cefotaxime (CTX, + 81 %), dont le niveau restait cependant inferieur a celui de la CRO. Les CAB de penemes etaient stables : 6,8 vs 6,7 DDJ/1000 JH (− 1,6 %). Avec une diminution pour l’imipeneme (IPM, − 31 %), mais une augmentation pour le meropeneme (MEM, + 82 %), dont la CAB devenait superieure a celle de l’IPM. Les CAB de fluoroquinolones (FQ) ont baisse de 40,0 a 30,7 DDJ/1000 JH (− 23 %). Les CAB d’ATB anti staphylocoque resistant a la meticilline (SRM) ont augmente de 8,9 a 9,4 DDJ/1000 JH (+ 5 %) : glycopeptides (GP) − 13 %, linezolide + 2 %, daptomycine + 134 %. En reanimation (cohorte de 17 ES, dont 4 CHU), la CAB totale a peu diminue, de 1509,1 a 1450,6 DDJ/1000JH (− 4 %). Les CAB de C3G ont augmente de 194,2 a 227,5 DDJ/1000 JH (+ 17 %). Celles de CRO ont diminue de 52 %, depassees par celles de CTX (+69 %) et de cefepime (+ 106 %). Les CAB de piperacilline-tazobactam etaient stables : 96,2 vs 94,3 DDJ/1000 JH (− 1,9 %). Les CAB de penemes ont augmente de 84,5 a 91,0 DDJ/1000 JH (+ 7,7 %). Celles d’IPM ont baisse de 39 %, depassees par celles de MEM (+161 %). Les CAB de FQ ont diminue de 130,1 a 77,0 DDJ/1000 JH (− 41 %). Celles de colistine ont augmente de 27,6 a 35,3 DDJ/1000 JH (+ 28 %). Les CAB d’ATB anti SRM ont augmente de 63,9 a 78,2 DDJ/1000 JH (+ 22 %). Celles de GP ont augmente de 12 %, de linezolide ont baisse de 17 %, et de daptomycine ont triple (+ 215 %). Conclusion Cette surveillance montre une relative stabilite des CAB totales, mais une modification du profil des ATB les plus consommes. Il est difficile de determiner si ces modifications s’expliquent par l’ecologie microbienne locale des ES concernes. Et de savoir quel est l’impact ecologique de ces evolutions.

Introduction Les infections neonatales tardives (INT) sont des infections survenant chez des nouveau-nes (NN) apres 72 heures de vie. Ces infections touchent 10 a 30 % des grands prematures, nes avant 32 semaines d’amenorrhee (SA), pendant leur sejour en unite de soins intensifs ou en reanimation, et sont responsables d’une augmentation de la mortalite et de la morbidite a court et long terme. Le role de facteurs perinataux est peu connu. L’objectif de ce travail est d’evaluer l’impact du petit poids de naissance (PN) pour l’âge gestationnel (PAG) sur le risque de survenue de bacteriemie liee au catheter (BLC), principale INT, chez les grands prematures porteurs de catheter central (CVC) nes entre 24 et 32 SA. Materiels et methodes Les infections chez les grands prematures porteurs d’un CVC, inclus entre le 01/01/2015 et le 31/12/2017 dans un reseau inter-regional de surveillance des infections sur CVC en neonatologie, ont ete analysees. Une BLC etait definie par la presence d’une hemoculture positive apres 72 heures de vie, en presence d’un CVC. Le PAG etait defini par un PN http://www.audipog.net ). Resultats Dans cette population, l’AG median etait de 29 SA, le PN median de 1100 g, et 14,2 % des NN etaient PAG. Parmi 4280 NN inclus, 818 (19,1 %) ont developpe au moins un episode de BLC. Les microorganismes identifies etaient des staphylocoques a coagulase negative (74,5 %), des enterobacteries (10,5 %), S. aureus (9,1 %), des bacilles a Gram negatif (1,7 %) ou des levures (1,5 %). Il n’y avait pas de difference des microorganismes identifies entre les deux groupes. Les facteurs associes au risque de BLC en analyse uni variee etaient le fait d’etre ne dans l’etablissement (inborn), et d’etre PAG (25,2 vs 18,1 %, p Conclusion Les grands prematures porteurs de CVC nes avec un PAG ont un risque augmente de survenue de BLC.

Introduction La resistance aux antibiotiques (ATB) est liee a leurs consommations (CAB). La diminution des CAB passe par une politique de bon usage (BU). Celle-ci peut etre evaluee notamment par l’indicateur composite de BU des ATB (ICATB2). La surveillance des CAB permet d’evaluer leur evolution. Notre objectif etait d’identifier les items d‘ICATB2 associes a une diminution de la CAB dans les etablissements de sante (ES) d’Ile de France de 2013 a 2016. Materiels et methodes L’evolution des items ICATB2 (exprimes en oui/non) a ete analysee entre 2013 et 2015. L’evolution de 2014 a 2016 des donnees de CAB du reseau ATB-Raisin, exprimees en dose definie journaliere (DDJ)/1000 journees d’hospitalisation (JH), a ete discretisee en diminution (variation CAB Resultats L’etude a inclus 105 ES : 14 universitaires, 67 prives et 24 prives d’interet collectif. De 2014 a 2016, la CAB totale a peu varie, mediane (IQR) : 385,8 (183,0–562,6) vs 387,0 (192,3–615,9) DDJ/1000 JH. Pour la plupart (78 %) des items ICATB2, le nombre d’ES ayant repondu « oui » a progresse entre 2013 et 2015. L’informatisation de la prescription d’ATB representait la plus forte progression (+42 %). La mise en place d’une restitution en commission medicale d’etablissement (CME) des resultats d’evaluations de qualite des prescriptions realisees les 3 dernieres annees (respect de la molecule, posologie, duree, reevaluation a 72 h, readaptation du traitement), etait significativement associee a une diminution des CAB totale (OR = 14,0 ; IC95 1,57–125,5), d’amoxicilline-acide clavulanique (AMC) (OR = 6,1 ; IC95 1,10–33,57) et de cephalosporines de 3e generation (C3G) (OR = 5,4 ; IC95 1,23–23,87). La mise en place de l’informatisation de la prescription d’ATB etait significativement et inversement associee a une diminution de la CAB totale (OR = 0,3 ; IC95 0,09–0,81) et d’AMC (OR = 0,3 ; IC95 0,10–0,76). La mise en place d’une connexion informatique entre services prescripteurs, laboratoire de microbiologie et pharmacie etait significativement associee a une diminution de la consommation d’AMC (OR = 8,9 ; IC95 1,44–54,71). Conclusion La restitution en CME des evaluations de qualite des prescriptions et la connexion informatique entre services prescripteurs, laboratoire de microbiologie et pharmacie pourraient jouer un role dans la maitrise des CAB (notamment CAB totale, AMC, C3G). Ces resultats demandent a etre valides, afin de cibler le type d’actions pouvant contribuer a maitriser les CAB.

Summary Objective Candidaemia is a life-threatening infectious disease, associated with septic shock, multiple organ failure, and a high mortality rate. In France, reported data on the incidence of ICU-acquired candidaemia and the causative Candida species are scarce. The objective of this study was to determine temporal trends in epidemiology and risk factors of intensive care unit-acquired candidaemia (ICU-Cand) and ICU mortality among a very large population of ICU patients. Method Demographics, patient risk factors, invasive device exposure and nosocomial infection in ICU patient were collected from 2004 to 2013 in a national network of 213 ICUs: REA-RAISIN. Incidence and risk factors for candidaemia and ICU mortality were assessed. Results Out of 246,459 ICU patients, 851 developed an ICU-cand, representing 0.3 per 1000 patients-days. The incidence rose sharply over time. Candida albicans was the main species. The overall and ICU mortality was 52.4% in ICU-cand patients. The main risk factors of ICU-cand were length of stay, severity of illness and antimicrobial therapy at ICU admission, immune status and use of invasive procedure. ICU-cand was an independent risk factor of mortality (OR: 1.53; 95%CI [1.40–1.70]); in a sub-group analysis, independent effects on mortality were observed with C. albicans (OR: 1.45 [1.23–1.71]), Candida tropicalis (OR: 2.11 [1.31–3.39]) and "other" Candida species (OR: 1.64 [1.09–2.45]). Conclusion ICU candidaemia ranked sixth among bloodstream infections, and its average annual incidence was 0.3 per 1000 patients days. Despite of new therapy and international recommendation, the incidence rose sharply during the study period, and ICU mortality remained high.

International audience

Resume Le reseau NEOCAT, anime par le Centre de coordination de lutte contre les infections nosocomiales (CCLIN) Paris-Nord, propose depuis 2006 une surveillance en reseau des bacteriemies liees aux catheters veineux centraux (CVC) (bacteriemies liees au catheter [BLC]) en neonatologie. Les resultats de la surveillance 2010 sont presentes dans cette etude. Les services de neonatologie volontaires incluaient, toute l’annee, tous les nouveau-nes lors de la pose d’un CVC quels que soient la pathologie et le motif de pose. Les catheters veineux ombilicaux (CVO) et les autres CVC ont ete analyses separement. En 2010, 26 services ont participe (niveau III 15, niveau IIB 10, niveau IIA 1). Ils ont inclus 2953 nouveau-nes d’âge gestationnel (AG) median de 32 semaines et de poids de naissance (PN) median de 1550 g. Ces nouveau-nes etaient porteurs de 2551 CVO (duree mediane de maintien 4 j) et 2147 CVC (duree mediane 12 j). Trente-trois BLC ont ete identifiees sur CVO correspondant a une densite d’incidence (DI) de 2,9/1000 j-CVO, IC 95 % (1,9–3,8). Le delai median d’apparition etait de 5 j apres la pose du CVO. Les principaux micro-organismes isoles par les hemocultures etaient des staphylocoques a coagulase negative (SCN, n = 27), S. aureus ( n = 3), et des enterobacteries ( n = 5). Trois cent six BLC ont ete identifiees sur CVC soit une DI de 11,2/1000 j-CVC, IC 95 % (10,0–12,5) (delai median d’apparition 12 j apres la pose du CVC). Les principaux micro-organismes isoles par les hemocultures etaient egalement des SCN (83 %), S. aureus (6 %), et des enterobacteries (5 %). Cette surveillance constitue un referentiel sur la DI des BLC en neonatologie permettant aux etablissements de sante de se comparer entre eux.

Purpose of review Among a wide range of publications on surgical-site infections (SSIs), many issues are still controversial, especially those concerning their monitoring and feedback. This review focuses on recent advances in surveillance as a tool for improving healthcare quality performance in surgery. Recent findings Recent data were obtained from many reference surveillance systems which tend to demonstrate significant decrease in SSI incidence rates over a several-year period. Most studies emphasize data feedback to surgical team is an important way to improve care quality and surgical performance. Few data demonstrated the relationship between the lack of compliance to control measures and SSI risk, including suboptimal antibiotic prophylaxis, perforated gloves, control of blood glucose, and avoidance of shaving. No clear consensus is achieved yet regarding preoperative systematic screening and decolonization of multidrug-resistant Staphylococcus aureus. There is a good amount of recent data regarding the benchmark approach for ranking surgery wards according to SSI rates. However, methodological issues on SSI indicator for public reporting are still being debated. Pilot studies attempt to demonstrate the usefulness of more cost-effective surveillance systems, especially those based on automated data process. Summary There are new exciting developments and perspectives in the field of surveillance and control of SSI. More data are needed to better establish the relationship with global care quality.

Surgical-site infections (SSIs) are a key target for nosocomial infection control programmes. We evaluated the impact of an eight-year national SSI surveillance system named ISO-RAISIN (infection du site opératoire – Réseau Alerte Investigation Surveillance des Infections). Consecutive patients undergoing surgery were enrolled during a three-month period each year and surveyed for 30 days following surgery. A standardised form was completed for each patient including SSI diagnosis according to standard criteria, and several risk factors such as wound class, American Society of Anesthesiologists (ASA) score, operation duration, elective/emergency surgery, and type of surgery. From 1999 to 2006, 14 845 SSIs were identified in 964 128 patients (overall crude incidence: 1.54%) operated on in 838 participating hospitals. The crude overall SSI incidence decreased from 2.04% to 1.26% ( P < 0.001; relative reduction: −38%) and the National Nosocomial Infections Surveillance system (NNIS)-0 adjusted SSI incidence from 1.10% to 0.74% ( P < 0.001; relative reduction: −33%). The most significant SSI incidence reduction was observed for hernia repair and caesarean section, and to a lesser extent, cholecystectomy, hip prosthesis arthroplasty, and mastectomy. Active surveillance striving for a benchmark throughout a network is an effective strategy to reduce SSI incidence.

Summary Introduction Although peripheral venous catheter (PVC) placement is one of the most common invasive procedures used in hospitals, data about the infectious risk associated with it are sparse. Nurses and physicians often underestimate this risk. We describe here a 10-year continuous quality improvement program in a large university hospital. Methods The prevention program included: 1/ an observational audit of practices of PVC insertion and maintenance (1996), 2/ two studies of incidence and risk factors for PVC-related infection (1996 and 1999), 3/ 8 annual (1996 to 2006) cross-sectional studies that collected information about duration of PVC placement and other process indicators, 4/ surveillance of nosocomial bacteremia from 2002 through 2006, and 5/ continued education sessions for healthcare workers, based on local surveillance data. Results Rates of colonization and infection (0.7 cases of bacteremia/1000 PVC days) were similar to data from other studies. PVC that remained in place for more than three days was associated with a higher risk of catheter-related bacteremia in both incidence studies. The annual prevalence studies showed that 15 to 20% of PVCs remained in place for more than three days from 1996 through 2002, but this rate decreased thereafter; it was 6.7% in 2005 and 10.7% in 2006. Practices audits indicated room for improvement in prevention measures. The absolute number of PVC-related bacteremia decreased by more than 50% from 2002 (n = 23) to 2006 (n = 10). Conclusion This prolonged multifaceted program, including practice audits, continued medical education and monitoring of PVC-related infection, has led to a substantial decrease over time in the infectious risk related to PVC placement.

Central venous catheter (CVC)-related infections (CRIs) are a key target for infection control in intensive care units (ICUs). The aim of this study was to describe temporal trends of CRI incidence in a network of volunteer ICUs in Northern France. During a 4 month surveillance period each year, all CVCs in place for more than 48h were prospectively followed until removal or patient discharge. Standard clinical and microbiological criteria were used to define colonization and CRI. The standardized incidence ratio (SIR) was estimated by dividing the number of observed CRIs by the number of expected CRIs, which was computed using a logistic regression model including risk factors for CRI. CRI incidence and SIR were fed back to ICUs as a benchmark at the end of each period. From 2001 to 2005, 135 ICUs participated for at least one surveillance period. Overall, 11 703 CVC in 9182 patients (122 495 CVC-days) were included. CRI incidence was 2.8 per 1000 CVC-days. Among 35 ICUs that participated for three or more consecutive periods, CRI incidence decreased significantly by 58.6%. SIR also decreased significantly from the first to the third surveillance period in these ICUs. These results suggest that surveillance programmes have a significant impact on CRI risk in ICUs and remain an important strategy for combating nosocomial infections in these settings.

The register of activity at the Ebola Treatment Center (ETC) in Forecariah (Guinea), from April 23 to June 5, 2015 is presented for analysis. The viral load of each patient is evaluated by the cycle threshold (Ct). One hundred and thirty patients were seen in Triage at the ETC, of which 24 (18.5%) patients who failed to meet theWHO case criteria for viral hemorrhagic fever were excluded from admission to the ETC. Of the 106 patients admitted in the ETC, 72 (67.9%) were declared non-cases after the results of their two PCR (drawn 48 hours apart) tests were negative. Thirty-four patients were tested positive for Ebola virus disease (EVD): 19 women and 15 men (sex ratio: male/female = 0.78), mean age of 33.51 ± 20.1 years (extremes of 42 days to 70 years), of which six children were aged below 8 years. The median initial Ct value was 21.6 ± 6.3 cycles in this group. Enquiry into patient contacts was only able to identify actual contacts in 20 of these patients (58.8%). Thirteen patients were ultimately cured of EVD (six men and seven women) - with a median age of 31.8 years (extremes of 4 to 54 years). These patients presented on admission with a median Ct value of 21.88 ± 6.2 cycles (extremes of 17.6 to 31.7). Of the six children aged below 8 years, only one survived. Twenty-one patients (61.76%) with EVD died (9 men and 12 women) - median age, 34 ± 21 years (extremes of 42 days to 70 years). They presented on admission with a median Ct value of 18 ± 7 cycles (extremes of 12 to 24). The single most important factor associated with lethality was the Ct value at the time of admission to the ETC (P = 0.0004), i.e., the lower the Ct value, the higher the lethality rate or simply stated, the higher the viral load, the greater the lethality. Age, sex, identification of contact, and delay between the onset of symptoms and admission did not prove to be predictive of death outcome in our series.

Ebola virus disease (EVD) is associated with a high lethality rate even when the afflicted are provided with good support in an Ebola treatment center (ETC). Basic laboratory tests can help to better understand the pathophysiology of the disease, to guide treatment and to establish simple protocols and procedures tailored to the practice of medicine in the context of such precarious environment for caregivers. Based on a few clinical cases of patients treated in the ETC of Forecariah, Guinea, run by the French Red Cross, this article describes the difficult conditions associated with the provision of medical practice in this challenging environment, aiming to minimize the casualties in the EVD patient and to train the health staff.

Background Accidental exposures to blood of body fluids (ABE) expose health care workers (HCW) to the risk of occupational infection. Objectives Our aim was to assess the prevention equipment available in the operating theater (OT) with reference to guidelines or recommendations and its use by the staff in that OT on that day and past history of ABE. Methods Correspondents of the Centre de Coordination de la Lutte contre les Infections Nosocomiales (CCLIN) Paris-Nord ABE Surveillance Taskforce carried out an observational multicenter survey in 20 volunteer French hospitals. Results In total, 260 operating staff (including 151 surgeons) were investigated. Forty-nine of the 260 (18.8%) staff said they double-gloved for all patients and procedures, changing gloves hourly. Blunt-tipped suture needles were available in 49.1% of OT; 42 of 76 (55.3%) of the surgeons in these OT said they never used them. Overall, 60% and 64% of surgeons had never self-tested for HIV and hepatitis C virus (HCV), respectively. Fifty-five surgeons said they had sustained a total of 96 needlestick injuries during the month preceding the survey. Ten of these surgeons had notified of 1 needlestick injury each to the occupational health department of their hospital (notification rate, 10.4%). Conclusion The occurrence of needlestick injury remained high in operating personnel in France in 2000. Although hospitals may improve access to protective devices, operating staff mindful of safety in the OT should increase their use of available devices, their knowledge of their own serostatus, and their ABE notification rate to guide well-targeted prevention efforts.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 35 - N° 3 - p. 247-256

Resume De nombreux agents pathogenes sont susceptibles d'etre transmis a l'occasion de l'exposition a du sang ou a un liquide biologique. L'essentiel du risque est represente par les virus de l'immunodeficience humaine (VIH) ou des hepatites B (VHB) et C (VHC). Le risque VIH est souvent connu compte tenu de la gravite de ses consequences. Cependant le risque VHC plus repandu dans la population generale, plus transmissible et contre lequel il n'existe ni vaccin ni prophylaxie post-exposition, ne doit pas etre sousestime. Le risque lie au VHB devrait etre nul compte tenu de la vaccination, mais il faut garder a l'esprit que la couverture vaccinale des personnels de sante est imparfaite et ne pas oublier le probleme des non repondeurs a la vaccination. Le paludisme peut etre transmis au cours d'un AES. Les risques lies a la maladie de Creutzfeldt-Jakob (MCJ) ou aux fievres hemorragiques virales (FHV) peuvent necessiter de contraignantes mesures de prevention mais en pratique ils sont soit rares (FHV) soit hypothetiques (MCJ). Le respect des precautions standard reste dans tous les cas l'element essentiel de la prevention de la transmission de l'ensemble de ces agents pathogenes.

Position du probleme La surveillance epidemiologique des infections nosocomiales est l’un des axes importants de l’amelioration de la qualite des soins dans les etablissements de sante. Les services participant a un reseau ayant des methodes standardisees peuvent etre compares entre eux en utilisant des indices de risque ajustes. Au sein du reseau de surveillance des infections liees aux catheters veineux centraux (ILC) en reanimation (REACAT), nous proposons un indice de risque ajuste sur plusieurs facteurs de risque des ILC : le ratio standardise d’incidence (RSI). Methodes Tous les catheters veineux centraux (CVC) maintenus plus de 48h etaient surveilles en prospectif, 4 mois par an. Les ILC etaient definies sur des criteres cliniques et microbiologiques consensuels. Un modele de regression logistique, developpe sur les donnees regroupees des trois dernieres periodes de surveillance, a ete retenu comme modele predictif de l’ILC. Pour chaque service et annee, un nombre d’ILC attendu a ete calcule et a permis d’estimer le RSI. Resultats Entre 2000 et 2003, 108 services ont participe a au moins une des periodes de surveillance, incluant 6 414 CVC. Deux cent trente neuf ILC ont ete identifiees, soit une densite d’incidence (DI) de 3,6 ILC/1000 jours d’exposition aux CVC. Les facteurs associes a l’ILC etaient la duree de maintien (OR ajuste = 1,1 ; IC95 % [1,0-1,1]), le rang de pose (1,7 ; [1,1-2,2]), le site d’insertion (1,6 ; [1,2-2,1]), la perfusion d’antibiotique (0,5 [0,3-0,7]), l’existence d’au moins une defaillance viscerale (2,2 [1,5-3,2] ) et d’une infection a un autre site a l’ablation du CVC (1,9 [1,4-2,6]). Parmi les 14 services avec une DI superieure a 5,5 ILC/1 000 jours-CVC (correspondant au 75 e percentile), seulement 2 avaient un RSI significativement superieur a 1, dont un seul avait inclus plus de 20 CVC. Conclusion La surveillance REACAT a permis la construction d’un RSI, indice de risque global et robuste, permettant d’identifier des services ou le risque d’ILC est eleve et d’orienter les actions de prevention.

Health care workers (HCW) in haemodialysis units are confronted with a significant risk of occupational exposure to blood and body fluids. The prevalence of bloodborne viruses is high among haemodialysis patients. The data presented here relates to the extraction of 121 occupational exposures notified to occupational health departments by haemodialysis HCW, documented between January 1995 and December 1999 in a network of 54 volunteer hospitals in Northern France. The exposures notified in haemodialysis wards were needlestick injuries in 85 cases (70.2%), splashes to the eyes or non-intact skin in 30 cases (24.8%) and cuts in 6 cases (5.0%). Connection and disconnection of dialysis catheters to fistulae, blood sampling procedures and injections alone were involved in approximately 3 notified exposures out of 4 (46.3, 14.9 and 11.6% respectively for a total of 72.8%). The principal mechanisms for exposure were the handling of blood-soiled needles and instruments or involved the handling of sharps containers. Haemodialysis fistula needles were involved in only 12 (13.2%) of notified percutaneous injuries. Nearly 2/3 (63%) of 91 notified percutaneous injuries could have been avoided by the observance of universal/standard precautions alone and the use of safety devices which were available at the time. The collection and analysis of occupational exposures can serve as basis for an assessment of practices, devices and safety equipment to increase HCW safety in haemodialysis wards.

The aim of this study was to evaluate the number of deaths associated with nosocomial infections (NI) and the contribution of these NI to death. A multicentre descriptive study was conducted in 16 tertiary-care hospitals (14 222 beds) in Northern France. Medical records of consecutive patients who died at least 48 h after admission were reviewed for cause of death, NI and disease severity, before admission and before NI onset. The contribution of NI to death was assessed by agreement between two physicians according to a three-category scale of probability. Among the 1945 patients who died during the study, 26.6% had an NI. According to the agreed diagnosis, NI contributed to the deaths of 284 (14.6%) patients (certainly for 6.6% and possibly for 8%), thereby ranking NI as the fourth most frequent cause of death. Considering the deaths that had not been anticipated independently of NI two weeks before they occurred, NI definitely contributed to 2.8% of them. Lower respiratory tract, bloodstream and surgical wound infections were responsible for 39, 20 and 14%, respectively, of all NI in these patients. The impact of NI on in-hospital mortality seems to be lower than had previously been estimated in France based on US data from the 1970s and 1980s. To improve healthcare quality, further studies are needed to elucidate the processes that may contribute to fatal severe NI.

La prevention de l’acquisition d’une infection par un soignant constitue le cœur de metier des professionnels de la lutte contre les infections associees aux soins et des professionnels de la sante au travail car : – une infection acquise par un soignant au cours de son activite dans un etablissement de sante (ES) est une infection nosocomiale ; – un soignant atteint d’une maladie contagieuse peut participer a la diffusion epidemique de celle-ci dans l’ES ; – une infection chez un soignant peut conduire, lorsqu’elle est grave et/ou contagieuse a un arret de travail de ce soignant, arret de nature a destabiliser le fonctionnement du service. La vaccination du personnel de sante (PS) est une des missions importantes des services de sante au travail. La vaccination est un moyen de prevention primaire efficace ayant permis de diminuer, de controler, voire d’eradiquer de nombreuses maladies infectieuses a prevention vaccinale assurant la protection des populations. Ainsi, la promotion de la vaccination par une politique vaccinale volontariste represente un enjeu majeur de sante publique. Pour guider les pratiques, des recommandations vaccinales existent dont certaines concernent specifiquement les PS et autres personnels en contact avec des sujets a risque dans les domaines de la sante et du medico-social. Malgre ces recommandations, hormis quelques travaux ayant montre que si les PS etaient globalement bien couverts par les vaccinations obligatoires, ils etaient en revanche tres insuffisamment couverts par les vaccinations recommandees, les donnees de couverture vaccinale (CV) chez le PS ne sont pas nombreuses en France. En 2013, une action nationale prioritaire d’evaluation et de suivi de la CV dans les ES a ete suggeree, proposition reprise dans les orientations du Propias 2015. Pour cette raison, le choix a ete fait de deployer le carnet de vaccination electronique (CVE) de MesVaccins.net (association loi 1901 a but non lucratif). Celui-ci est dote d’un systeme expert qui : – assure un diagnostic personnalise, precis et immediat de l’etat vaccinal de chaque personnel, et fournit une aide a la decision ; – permet d’etre alerte des vaccinations a programmer, avec integration en temps reel de l’evolution des recommandations vaccinales ; – informe des eventuelles donnees de pharmacovigilance a prendre en compte. Le reseau national coordonne par le Raisin se donne pour objectif de deployer cette methode standardisee de recueil et de suivi des vaccinations et des conditions d’immunisation du personnel des ES a partir du CVE de MesVaccins.net. La phase pilote debute en 2016. Dans un deuxieme temps, le dispositif explorera la capacite de generer chez les soignants des donnees de CV a differents echelons geographiques.

Introduction L’antibioprophylaxie chirurgicale (ABP) fait partie des mesures de prevention des infections du site operatoire (ISO). Depuis 2014, un module optionnel sur l’ABP est associe a la surveillance nationale des ISO, afin d’evaluer si l’incidence des ISO varie selon que l’ABP est administree ou non en conformite avec les recommandations de la societe francaise d’anesthesie et de reanimation (SFAR). Materiels et methodes L’etude utilisait les donnees 2014 et 2015 de la surveillance nationale des ISO (interventions jugees prioritaires). L’incidence des ISO a ete comparee, en analyse univariee et par discipline chirurgicale, d’une part selon que l’ABP recommandee etait realisee ou non, et d’autre part suivant que l’administration ABP etait conforme au referentiel 2010 de la SFAR ou non. Resultats En 2014 et 2015, 353 services (23,5 % des services participant a la surveillance) ont participe au module ABP. Parmi les 12 109 interventions de gynecologie-obstetrique, l’incidence des ISO etait plus elevee pour les interventions avec ABP recommandee et non realisee que pour les interventions avec ABP recommandee et realisee : OR = 2,14, IC95 % [1,31–3,48], p = 0,002. Sur les ABP recommandees et realisees, 55,9 % etaient conformes au referentiel. Parmi les 1928 interventions de neurochirurgie, l’incidence des ISO etait plus elevee pour les interventions avec ABP recommandee et non realisee que pour les interventions avec ABP recommandee et realisee : OR = 4,70, IC95 % [1,56–14,20], p = 0,006. Sur les ABP recommandees et realisees, 35,7 % etaient conformes au referentiel. Les ABP non-conformes l’etaient en raison du delai d’administration majoritairement trop tot ; 90,5 % des administrations en chirurgie gynecologie-obstetrique et 93,3 % des administrations en neurochirurgie. Conclusion L’introduction, dans la surveillance ISO, d’un module ABP a permis de montrer que la non-conformite de l’ABP, facteur de risque d’ISO connu, est associe a une incidence plus elevee des ISO dans certaines specialites. Ces resultats, qui soulignent l’interet de coupler evaluation de pratiques et surveillance epidemiologique, ont amene le comite de pilotage de la surveillance a integre un representant de la SFAR parmi ses membres.

Background Multisite information regarding surgical site infection (SSI) rates for cardiac surgery programmes is not widely available. Ward characteristics that may affect outcomes have not been analysed previously. Aim To determine individual- and ward-level factors associated with SSI occurrence after coronary artery bypass grafting (CABG) and valvular surgery. Methods A dataset from the French national SSI database ISO-RAISIN 2008–2011 was used. Only adult patients were included. A standardized questionnaire was completed for each patient who underwent surgery, and patients with and without SSI were characterized. Patients and ward risk factors for SSI were analysed using a multilevel logistic regression model with SSI as binary outcome (two levels: patient and ward). Results Out of 8569 patients from 39 wards, the SSI rate was 2.2%. Micro-organisms were isolated in 144 patients (74%): 35% coagulase-negative staphylococci (N = 51), 23% Staphylococcus aureus (N = 33), 6% Escherichia coli (N = 8). Higher probability of SSI was associated with the duration of preoperative hospitalization, the duration of follow-up, the duration of surgery >75th percentile and the SSI rate in the surgery ward. The residual heterogeneity between wards (median odds ratio: 1.53) was as relevant as duration of preoperative hospitalization (odds ratio: 1.57). Conclusion Although patient risk factors were more strongly associated with SSI occurrence, this study provided evidence for the existence of a ward-level effect. This should be taken into account when considering possible corrective interventions.

Studies provide evidence that reduced nurse staffing resources are associated to an increase in health care-associated infections in intensive care units, but tools to assess the contribution of the mechanisms driving these relations are still lacking. We present an agent-based model of pathogen spread that can be used to evaluate the impact on nosocomial risk of alternative management decisions adopted to deal with transitory nurse shortage., We constructed a model simulating contact-mediated dissemination of pathogens in an intensive-care unit with explicit staffing where nurse availability could be temporarily reduced while maintaining requisites of patient care. We used the model to explore the impact of alternative management decisions adopted to deal with transitory nurse shortage under different pathogen- and institution-specific scenarios. Three alternative strategies could be adopted: increasing the workload of working nurses, hiring substitute nurses, or transferring patients to other intensive-care units. The impact of these decisions on pathogen spread was examined while varying pathogen transmissibility and severity of nurse shortage., The model-predicted changes in pathogen prevalence among patients were impacted by management decisions. Simulations showed that increasing nurse workload led to an increase in pathogen spread and that patient transfer could reduce prevalence of pathogens among patients in the intensive-care unit. The outcome of nurse substitution depended on the assumed skills of substitute nurses. Differences between predicted outcomes of each strategy became more evident with increasing transmissibility of the pathogen and with higher rates of nurse shortage., Agent-based models with explicit staff management such as the model presented may prove useful to design staff management policies that mitigate the risk of healthcare-associated infections under episodes of increased nurse shortage.

Purpose Surveillance of preventable healthcare associated infections and feedback of the results to clinicians is central in the efforts to improve performance. We assessed Staphylococcus aureus healthcare associated bloodstream infection (HA-BSI) as an indicator of healthcare quality. Patients and method Between 2002 and 2012, we carried out a ten-year prospective bedside surveillance of S. aureus healthcare associated bacteraemia in a 940-bed university hospital using standard definitions. Results Overall, 2784 HA-BSI were identified during the study period, among which 573 (18%) were due to S. aureus . Among these 573 S. aureus bacteraemias, 189 originated from intravascular catheters (32.8%) of which 84% (158/189) in patients outside intensive care units. The proportion of catheter related HA-BSI due to S. aureus was 56% (61/109) in PVC-related HA-BSI and 34% (103/301) in CVC-related HA-BSI. A sharp decrease of PVC-related HA-BSI from 20 to 7 per year was obtained during the same period. Conclusion In our experience, S. aureus HA-BSI is a simple and useful indicator of catheter associated infections, and therefore of healthcare quality, especially in units not covered by other type of surveillance.

RP 59500 is a new injectable streptogramin composed of two synergistic components (quinupristin and dalfopristin) which are active against a number of erythromycin-susceptible and -resistant gram-positive bacteria. The following experiments investigate the ability of RP 59500 to prevent experimental endocarditis due to either of two erythromycin-susceptible streptococcal isolates or their constitutively erythromycin-resistant Tn916 delta E transconjugants. RP 59500 had low MICs (0.125 to 0.5 mg/liter) for all four test organisms and was substantially bactericidal in vitro. Rats with catheter-induced aortic vegetations were given single-dose antibiotic prophylaxis 30 to 60 min before bacterial inoculation through a computerized pump system which permitted the simulation of drug kinetics for humans produced by either 7 mg of RP 59500 per kg of body weight or 1 g of vancomycin. Single-dose RP 59500 prophylaxis successfully prevented endocarditis due to both the erythromycin-susceptible parent strains and their erythromycin-resistant derivatives in rats challenged with the minimal inoculum infecting 90% of controls. In addition, RP 59500 also prevented infection in animals challenged with fivefold-larger inocula of the erythromycin-susceptible parent strains. Vancomycin successfully prevented endocarditis due to any of the four test organisms. These results underline the in vivo efficacy of RP 59500 against both erythromycin-susceptible and -resistant streptococci. Such good results against the resistant strains would not be expected with erythromycin or clindamycin, which are the standard macrolidelincosamide-streptogramin antibiotics used for endocarditis prophylaxis in humans. An oral form of RP 59500 which might advantageously replace some of the older prophylactic regimens is currently being developed.

The NEOCAT surveillance network was implemented in 2006 in order to address catheter-associated bloodstream infections (BSIs) in neonates. The results for 2010 surveillance are presented herein. Neonatal intensive care units (NICUs) participated in the study on a voluntary basis. Umbilical catheters (UCs) and central venous catheters (CVCs) were analyzed separately. In 2010, 26NICUs participated. Overall, 2953 neonates were included (median weight, 1550 g; median gestational age, 32 weeks). These neonates had 2551UCs (median insertion duration, 4 days) and 2147CVCs (median insertion duration, 12 days). Thirty-three BSIs associated with UCs were reported, yielding a 2.9/1000UC-day incidence density, 95% confidence interval (95%CI) (1.9-3.8). UC-associated BSIs appeared after a median period of 5 days after UC insertion. The main microorganism isolated from blood cultures was coagulase negative staphylococci (CNS, n=27), S. aureus (n=3), and Enterobacteriaceae (n=5). Three hundred and six CVC-associated BSIs were recorded, yielding a 11.2/1000 CVC-day incidence density (95%CI, 10.0-12.5). These BSIs occurred after a median period of 12 days after CVC insertion. The main microorganisms were CNS (83%), S. aureus (6%), and Enterobacteriaceae (5%). The NEOCAT network provides a useful benchmark for participating wards.

Pseudomonas aeruginosa is an important pathogen of complicated pneumonia in intensive care units (ICUs). Our objective was to determine 'patient' and 'ward' risk factors for P. aeruginosa pneumonia among patients with nosocomial pneumonia in ICU. Data from the 2004-2006 prospective French national nosocomial infection surveillance in ICUs (REA-RAISIN) were used, including patients admitted for >48 h in ICU and who developed nosocomial pneumonia. Only first pneumonia was considered and categorised as either P. aeruginosa pneumonia or other micro-organism pneumonia. Multilevel logistic regression model (patient as first level and ward as second) with P. aeruginosa pneumonia as binary outcome was performed. Of 3,837 included patients from 201 different wards, 25% had P. aeruginosa pneumonia. P. aeruginosa was significantly more frequent in late onset pneumonia. Higher probability of P. aeruginosa pneumonia was associated with higher age and length of mechanical ventilation, antibiotics at admission, transfer from a medical unit or ICU, and admission in a ward with higher incidence of patients with P. aeruginosa infections. Lower probability of P. aeruginosa was associated with traumatism and admission in a ward with high patient turnover. Our analyses identified a patient's profile and some ward elements that could make suspect P. aeruginosa in case of nosocomial pneumonia.

In France, Pseudomonas aeruginosa is the third most common isolate from nosocomial infections. To determine whether high consumption rates of some antibiotics are risk factors for resistance to ceftazidime, imipenem, ciprofloxacin and amikacin in P. aeruginosa, we conducted a study based on data from the Antimicrobial Surveillance Network in northern France and the French public reporting system of infection control indicators. These data were related to hospital characteristics (size, type, proportion of non-acute care beds), antibiotic consumption, incidence rates of some key resistances and quality indicators of healthcare-associated infection (HAI) control. In univariate analysis, high total and specific antibiotic consumption (except amoxicillin/clavulanate and imidazoles) were associated with high P. aeruginosa resistance rates. In multivariate analysis, high resistance rates were related to high imipenem and ciprofloxacin consumption [odds ratio (95% confidence interval): 7.9 (2.24-28.09), P

Objectives.To evaluate the incidence of needlestick injuries (NSIs) among different models of safety-engineered devices (SEDs) (automatic, semiautomatic, and manually activated safety) in healthcare settings.Design.This multicenter survey, conducted from January 2005 through December 2006, examined all prospectively documented SED-related NSIs reported by healthcare workers to their occupational medicine departments. Participating hospitals were asked retrospectively to report the types, brands, and number of SEDs purchased, in order to estimate SED-specific rates of NSI.Setting.Sixty-one hospitals in France.Results.More than 22 million SEDs were purchased during the study period, and a total of 453 SED-related NSIs were documented. The mean overall frequency of NSIs was 2.05 injuries per 100,000 SEDs purchased. Device-specific NSI rates were compared using Poisson approximation. The 95% confidence interval was used to define statistical significance. Passive (fully automatic) devices were associated with the lowest NSI incidence rate. Among active devices, those with a semiautomatic safety feature were significantly more effective than those with a manually activated toppling shield, which in turn were significantly more effective than those with a manually activated sliding shield (P < .001, x2 test). The same gradient of SED efficacy was observed when the type of healthcare procedure was taken into account.Conclusions.Passive SEDs are most effective for NSI prevention. Further studies are needed to determine whether their higher cost may be offset by savings related to fewer NSIs and to a reduced need for user training.

Objectives To prospectively evaluate a management approach to bacteriuria including advice from an infectious diseases consultant (IDC) in geriatric inpatients. Design Prospective study from July 1, 2003, to June 30, 2004. Setting A 205-bed geriatric university-affiliated hospital. Participants Consecutive hospitalized patients with positive urine cultures. Intervention The hospital's infection control department developed recommendations about antimicrobial use for bacteriuria, which were discussed at staff meetings. Treatments for bacteriuria prescribed by ward physicians were reviewed by an IDC, who suggested changes where appropriate. Physicians were free to follow or to disregard the IDC's suggestions. Measurements Patients with positive urine cultures (UC) were classified as having asymptomatic bacteriuria (AB), urinary tract infection (UTI) or pyelonephritis (PN). Prescribed and actual treatments were compared. Results Of 252 consecutive positive UCs in 181 patients, 124 (49%) were classified as AB, 88 (35%) as UTI, and 38 (15%) as PN; 2 cases of prostatitis were excluded. The total number of prescribed antimicrobial days before IDC advice was 729 and the actual number (after IDC advice) was 577, for a 152-day (21%) reduction. Most of the reduction was generated by shortening the treatment duration. Conclusion Intervention of an IDC resulted in reduced antimicrobial use in older inpatients with bacteriuria.

Objective.To estimate the incidence rate of reported occupational blood and body fluid exposures among French healthcare workers (HCWs).Design.Prospective national follow-up of HCWs from January 1 to December 31, 2004.Setting.University hospitals, hospitals, clinics, local medical centers, and specialized psychiatric centers were included in the study on a voluntary basis.Participants.At participating medical centers, every reported blood and body fluid exposure was documented by the occupational practitioner in charge of the exposed HCW by use of an anonymous, standardized questionnaire.Results.A total of 375 medical centers (15% of French medical centers, accounting for 29% of hospital beds) reported 13,041 blood and body fluid exposures; of these, 9,396 (72.0%) were needlestick injuries. Blood and body fluid exposures were avoidable in 39.1% of cases (5,091 of 13,020), and 52.2% of percutaneous injuries (4,986 of 9,552) were avoidable (5.9% due to needle recapping). Of 10,656 percutaneous injuries, 22.6% occurred during an injection, 17.9% during blood sampling, and 16.6% during surgery. Of 2,065 splashes, 22.6% occurred during nursing activities, 19.1% during surgery, 14.1% during placement or removal of an intravenous line, and 12.0% during manipulation of a tracheotomy tube. The incidence rates of exposures were 8.9 per 100 hospital beds (95% confidence interval [CI], 8.7-9.0 exposures), 2.2 per 100 full-time—equivalent physicians (95% CI, 2.4-2.6 exposures), and 7.0 per 100 full-time—equivalent nurses (95% CI, 6.8-7.2 exposures). Human immunodeficiency virus serological status was unknown for 2,789 (21.4%) of 13,041 patients who were the source of the blood and body fluid exposures.Conclusion.National surveillance networks for blood and body fluid exposures help to better document their characteristics and risk factors and can enhance prevention at participating medical centers.

Midwives appear to be the health care workers exposed to the highest rates of bloodborne injury. In this paper - based on a national survey - we describe the bloodborne injuries occurring in this profession.During the year 2003, 241 hospitals took part in a national survey of bloodborne injuries. Employees registered anonymous standardized reports of bloodborne events with the Occupational Medicine Unit. The data were processed by the coordination center for the fight against nosocomial infections (C. CLIN) which is in charge of the national analysis of all the events reported in this database.169 of the 6973 bloodborne events reported during 2003 (2.4%), were signed by midwives or midwife students. The first three most frequent accidents reported were: ocular projections during childbirth, pricks when repairing episiotomy, pricks or cuts when handling soiled instruments.Improving knowledge of risk as well as promotion of protection/prevention measures well adapted to this profession should be helpful in optimizing future attitudes.

The blood and body fluids exposure (BBFE) risk for health care workers varies according to numerous factors. Based on a needlestick surveillance in 13 French hospitals from 1997 to 2000, we evaluated incidence and temporal trends of BBFE according to medical devices causing needlestick injuries. We observed that the BBFE incidence per 100,000 peripheral venous catheters purchased decreased from 12.9 to 4.9, whereas incidence per 100,000 subcutaneous needles purchased increased from 8.7 to 14.3.

Objectives:To evaluate nosocomial infection (NI) surveillance strategies in French ICUs and to identify similar patterns defining subsets within which comparisons can be made.Design:A questionnaire was sent to all French ICUs, and a random sample of nonresponders was interviewed.Participants:Three hundred ninety-five responder ICUs (69%) in France.Results:In 282 ICUs (71%), a dedicated ICU staff member was responsible for infection control activities. The microbiology laboratory was usually in the hospital (90%) and computerized (94%) but issued regular hospital microbiology records in only 48% of cases. Patients receiving mechanical ventilation, central venous catheterization, and urinary catheterization were 90%, 79%, and 60%, respectively. Patients were screened for carriage of mul-tidrug-resistant bacteria on admission and during the stay in 70% and 60% of ICUs, respectively, most often targeting MRSA. Quantitative cultures were used to diagnose ventilator-associated pneumonia (VAP) in 90% of ICUs, including distal specimens in 80% and bronchoscopy specimens in 60%. Quantitative central venous catheter (CVC)-segment cultures were used in 70% of ICUs. All CVCs were cultured routinely in 53% of the ICUs. Despite wide variations in infection control and surveillance strategies, multiple correspondence analysis identified 13 key points (4 structural variables and 9 variables concerning the diagnosis of VAP, the surveillance and diagnosis of catheter-related and urinary tract infections, and the mode of screening of MRSA carriers) that categorize the variability of French ICUs' approaches to NIs.Conclusion:This study revealed profound differences in N1 surveillance strategies across ICUs, indicating a need for caution when using N1 surveillance data for comparisons and benchmarking.

Introduction – objectifs Etudier la consommation des antifongiques (ATF) dans les etablissements de sante (ES) francais en 2012. Materiels et methodes Les quantites d’ATF (classe J02 de l’OMS, systeme DDD/ATC) dispenses par la pharmacie dans les services de reanimation, d’hematologie et dans l’ensemble des services d’hospitalisation complete ont ete recueillies dans les ES volontaires participant au reseau ATB-RAISIN en 2012. Les donnees ont ete exprimees en nombre de doses definies journalieres (DDJ) pour 1 000 journees d’hospitalisation (JH). Resultats Dans les 239 ES participants, la consommation globale d’ATF etait de 18 DDJ/1 000 JH. Elle etait respectivement de 163 et 340 DDD/ 1 000 JH dans les 97 secteurs de reanimation et les 26 secteurs d’hematologie participant. Le fluconazole representait 63 % des ATF dans l’ES dans son ensemble (74 % en reanimation, 32 % en hematologie), l’amphotericine B 13 %, le voriconazole et la caspofungine 8 % chacun. Une grande variete d’antifongiques etait consommee en hematologie, avec une predominance du fluconazole et de l’amphotericine B (essentiellement sous forme liposomale), et une part de caspofungine, de voriconazole et de posaconazole superieure a 10 % des DDJ. En reanimation, la caspofungine etait le 2 e ATF le plus consomme (12 %) ; le profil d’utilisation variait selon le type d’ES, avec davantage d’amphotericine B dans les CHU. Conclusion Cette etude a permis pour la premiere fois de decrire les consommations de tous les ATF a visee systemique (et non les seuls ATF de la liste en sus) dans un grand nombre de secteur de reanimation et d’hematologie. Le suivi des consommations pourra permettre d’evaluer l’impact des actions de bon usage developpees. Les relations entre consommation et modification de l’ecologie fongique restent a explorer.

Background Surgical site infection (SSI) is one of the most frequent healthcare-associated infections. Since 1999, French authorities have set up a coordination of the regional surveillance networks to gather national SSI incidence data. In parallel, a national campaign was implemented to promote benchmarking through the network and guidelines on SSI preventive measures. The aim of the current study was to describe the largest database ever collected in France on SSI and to analyse temporal trends. Methods Surgery patients were enrolled by voluntary participating surgical wards in a yearly 3-month incidence survey. In each ward, 100 consecutive surgery procedures should be included and patients followed up to 30 days after surgery. SSI was defined based on standard international criteria. For each patient, risk factors were collected on the day of surgery including age, ASA score, Altemeier wound class, type and duration of procedure, emergency/elective, and when videoscopy surgery was performed. Regional and national reports were edited yearly feeding back the overall results of the network to all participants including the rank of surgery units. Temporal variation of incidence risk was tested using chi-square for linear trends and multivariate logistic regression model. Results Since 1999, 1 179 418 operations (35 626 300 operated patients-days follow-up; median post-operative follow-up: 29 days). The overall crude SSI incidence rate was 1.47%. Organ space and deep incisional SSI accounted for 42.7% although their proportion varied according to the type of surgery. SSI incidence rate increased from 0.84% for National Nosocomial Infections Surveillance system (NNIS)-0 patients to 5.94% for NNIS-2 and 3 patients. The SSI incidence varied from 0.49% for knee prosthesis to 9.24% for colon surgery. From 1999 to 2007, NNIS-0 SSI incidence decreased from 1.10 to 0.80 for 100 operated patients. Over the last 4 years (2004–2007), 65% of surgery wards had SSI incidence rate lower than the median reference value in 2004. The decrease was the most significant for hernia repair (−68%) and cholecystectomy (−62%) NNIS-0 incidence rates. Multivariate analysis showed a -29.5% relative decrease of SSI risk over the study period. Conclusion These encouraging results demonstrate the potential impact of the national policy on SSI reduction in France, although efforts have to be maintained for some specific surgery. Introduction Les infections de site operatoire (ISO) sont parmi les infections associees aux soins (IAS) les plus frequentes. Depuis 1999, la France a mis en place une coordination des reseaux de surveillance interregionaux afin d’evaluer l9incidence des ISO. Pendant la meme periode, une campagne nationale de promotion des mesures de prevention des ISO et d9incitation a la surveillance en reseau a ete mise en place. Le but de cette etude etait de decrire la plus grosse base de donnees sur les ISO existant en France et d9analyser ses tendances evolutives. Methodes Les services de chirurgie volontaires incluaient les patients operes dans la surveillance 3 mois par an. Chaque service devait inclure au moins 100 interventions consecutives, et chaque patient devait etre suivi au moins 30 jours apres l9intervention. Les ISO etaient definies selon les criteres standard internationaux. Pour chaque patient etaient recueillis les facteurs de risque d9ISO comprenant l’âge, le score ASA, la duree d9intervention, la classe de contamination d9Altemeier, le type d9intervention, la notion d9urgence, le recours a la videochirurgie. Chaque annee les services etaient informes de leurs propres resultats et des resultats regionaux et nationaux du reseau, leur permettant de se situer. Les variations temporelles ont ete analysees avec le test de chi-2 pour les tendances lineaires et une regression logistique pour l9analyse multivariee. Resultats Depuis 1999, 1.179.418 interventions (35.626.300 jours de suivi;mediane de suivi 29 jours) ont ete colliges. Le taux brut d9incidence des ISO etait de 1,47%. Les ISO profondes et d9organe/espace en representaient 42,7% avec des variations selon le type de chirurgie. L9incidence des ISO variait de 0,84% en NNIS-0 a 5,94% en NNIS-2, 3 et de 0,49% pour les poses de prothese de genou a .9,24% pour la chirurgie colorectale. De 1999 a 2007 l9incidence des ISO en NNIS-0 a diminue de 1,10% a 0,80%. Sur les quatre dernieres annees 1999–2007, 65% des services avaient un taux d9incidence des ISO inferieur au taux median de 2004. La decroissance etait particulierement sensible pour les cures de hernie (−68%), les cholecystectomies (−62%) en NNIS-0. L9analyse multivariee a montre une decroissance relative de 29,5% du risque d9ISO pendant la periode d’etude. Conclusions Ces resultats encourageants montrent l9impact potentiel d9une politique de reduction des ISO en France. Cependant l9effort doit etre maintenu pour certains types de chirurgie.

Introduction et objectifs Les infections nosocomiales (IN) liees aux catheters veineux centraux (CVC) representent une importante cause de morbidite en neonatologie. Le diagnostic y est le plus souvent fait en contexte de bacteriemie (BLC). Les Centres de Coordination de la Lutte contre les IN (CCLIN) Paris-Nord et Ouest ont mis en place en 2006 un reseau de surveillance des BLC en neonatologie. Materiels et methodes La participation etait volontaire. Tous les nouveau-nes (NN) etaient inclus lors de la pose d’un CVC dans le service, quels que soient la pathologie et le motif de pose. Les catheters veineux ombilicaux (CVO) et les autres CVC ont ete analyses separement. Resultats En 2007, 18 services ont participe : 1761 NN porteurs de 1528 CVO et 1126 autres CVC ont ete inclus. L’âge gestationnel (AG) median etait de 31 semaines d’amenorrhee (intervalle interquartiles (IIQ) [29-34]), le poids de naissance (PN) median de 1475 g (IIQ [1100-2075]). Une BLC a ete observee sur 28 CVO (incidence 3,9/1 000 jours ; IC 95 % [2,4-5,3]) et sur 130 CVC (incidence 7,5/1 000 jours ; IC 95 % [6,2-8,8]). Les micro-organismes isoles des hemocultures etaient principalement des staphylocoques a coagulase negative (73 %), des enterobacteries (5 %), et S. aureus (3 %). Les facteurs de risque associes a la survenue d’une BLC etaient la duree de maintien et le PN pour les CVO et la duree de maintien, l’AG, le materiau et le recours a une ventilation assistee pour les CVC. L’antibiotherapie (ABT) etait renseignee pour 70 episodes. Avant documentation bacteriologique, l’ABT (76 % des cas) comportait le plus souvent l’association vancomycine (94 %), beta-lactamine (BL, 79 %) et aminoside (91 %). Apres documentation, l’ABT (84 % des cas) comportait le plus souvent la vancomycine (86 %), associee a un aminoside (34 %) ou a une BL (32 %). Conclusion A terme, cette surveillance devrait permettre de definir des indicateurs de qualite de soins en neonatalogie.

Introduction et objectifs La surveillance en reseau des consommations d’AB (CAB) par un ES permet un suivi dans le temps, et la comparaison a d’autres ES. Le CCLIN Nord propose une surveillance en reseau depuis 2002. Materiels et methodes La participation repose sur le volontariat. Les CAB, totales et si possible par type de service, sont exprimees en Dose Definie Journaliere (DDJ) pour 1000 journees d’hospitalisation (JH). Resultats Cent cinquante-cinq ES ont fourni leurs donnees de CAB totales de 2007. La mediane des CAB totales etait de 381 DDJ/1000 JH (intervalle interquartile [IIQ] : 211-512). Les consommations medianes (IIQ) de beta-lactamines (BL) et fluoroquinolones (FQ) etaient respectivement 256 (134-360) et 49 (29-69) DDJ/1000 JH. Le tableau indique les CAB stratifiees par type de services des ES qui ont pu les fournir. MCO Medecine Chirurgie Gynecologieobstetrique Reanimation SSR SLD Nombre d’ES 88 45 38 31 29 64 31 CAB mediane [IIQ] 549 617 639 379 1437 230 82 (DDJ/1000 JH) [439- 678] [498- 772] [512- 781] [290-455] [1260- 1741] [174- 311] [51- 100] Dans tous les secteurs sauf en obstetrique, BL et FQ etaient les familles les plus consommees. En obstetrique, les macrolides occupaient la 2e position. Les molecules les plus consommees differaient selon les types de services. L’evolution des consommations a pu etre suivie sur 49 ES participants de 2005 a 2007 : La CAB totale moyenne a peu varie (−0,2 %). Les principales variations observees sont celles des consommations de piperacilline-tazobactam (+31,7 %), ceftriaxone (+23,2 %), ceftazidime (−20,1 %), ofloxacine (−14,4 %) levofloxacine (+17,2 %), teicoplanine (−19,8 %). Conclusion Ce reseau doit aider les ES a situer leurs CAB par rapport a celles des ES comparables (ceux dont les CAB s’ecartent des autres sont alertes individuellement), et a suivre leurs evolutions.